Effectiveness of Nurse-Coordinated, Digital-Supported Collaborative Care Model in Reducing Hospital Stay and Mortality Among Patients With Heart Failure: TIME-HF Cluster RCT (India).

In 30 seconds

This multicenter, parallel-group cluster-randomized trial assessed a nurse-coordinated, mobile health-supported collaborative care model in 1507 adults with heart failure with reduced ejection fraction at 22 centers in India. Over 2 years, the intervention combined risk stratification, treatment optimization, self-care education, active follow-up, and outpatient monitoring with usual care as the comparator. The intervention increased the probability of surviving 730 days without hospitalization from 34.7% to 46.5%. All-cause mortality was also lower: the adjusted hazard ratio was 0.78 (95% CI, 0.63-0.95; P =0.028).

Key findings

• The probability of surviving up to 730 days without hospitalization was 46.5% (95% CI, 42.6%-49.9%) with intervention and 34.7% (95% CI, 31.2%-38.1%) with usual care.
• Intervention participants had higher odds of spending all 730 days alive and out of hospital (odds ratio, 1.78 [95% CI, 1.42-2.23]).
• There were 163 deaths (21.59%) in the intervention group and 201 (26.73%) in usual care; adjusted mortality hazard ratio was 0.78 (95% CI, 0.63-0.95; P =0.028).

Why it matters

Heart failure with reduced ejection fraction is associated with substantial mortality and recurrent hospitalization in India. This trial suggests that coordinated follow-up combining nursing, mobile health support, self-care education, and treatment optimization can improve both time alive outside hospital and survival in this setting. The findings highlight the potential value of organized, continuing care alongside usual clinical management.

What to keep in mind

The trial was conducted in India among patients with heart failure with reduced ejection fraction; the abstract does not establish whether results generalize to other populations or health systems.